Ectopic Pregnancy in a Referral Hospital in the Volta Region of Ghana West Africa

Abstract

Background: Ectopic pregnancy is still a global problem for women of reproductive age with increasing burden of the disease and increasing mortality especially for women living developing world like Africa. In Ghana studies evaluating the burden of ectopic pregnancy have been conducted in major centres like Korle-Bu and KATH but few in other centres. This study tends to evaluate the prevalence, clinical presentation and finding of ectopic pregnancy in a referral hospital in the Volta region of Ghana. Methodology: This was a 3 years (2013)(2014)(2015)(2016) retrospective review of all gynaecological admission in the Volta regional hospital. All ectopic pregnancy cases/ record were identified, retrieved and information on the socio-demographics, clinical presentations, intraoperative findings and outcome of surgery were all extracted for analysis. Result: A prevalence of 2.05% (53/2582) was recorded over the study period. 58.5% (31/53) of the women were married and between the age group of 21 -30. 47.2% (25/53) had primary school education. Lower abdominal pain was common in 98.1% (52//53), 69.2% (37/53) had vaginal bleeding while 96.4% (51/53). Fallopian tube pregnancy was seen in 96.2% (51/53) while 3.8% (2/53) were abdominal pregnancy. Tubal rupture and heamoperitoneum were seen in 73.6% (39/53) of the women. 78.4% (40/51) of the fallopian tube pregnancy occurred at the ampulla. All the women in this study were successfully managed with radical surgery. Conclusion: There is still the need to evaluate the prevalence of ectopic pregnancy in the region. Proper education of women of reproductive age and provision of equipment and skills to enable early diagnosis of ectopic pregnancy is very necessary in ensuring less radical and traumatic management with less implication on fertility of women post-surgery.

Ectopic pregnancies in low resource setting: a retrospective review of cases in Kumasi, Ghana

“…19 However, in other studies in Ghana by Opoku et al and Oppong et al, a higher prevalence of 10.6% and 2.05% respectively was reported, with women aged between 21-30 years recording the highest. 1,4 This age group observed in the present study corresponds with the reproductive age and the stages where women are sexually active and tend to get married. This is also consistent with a similar study by Ayinde et al 20 In Ghana, this fertility age is a period most women get married and become mothers or expectant mothers, and hence these findings.…”

“…Pranathi and Madhavi, Oppong et al, and Tahmina et al have reported a similar findings with tubal ectopic accounting for 92.85%, 96.20% and 94.4% respectively. 1,22,23 The study further observed that the commonest site of tubal involvement is cornual accounting for 10.18% followed by fimbria and ampulla which accounted for 7.19% and 1.80% respectively. Contrary to the findings of the present study, a study conducted by Chate et al in Nanded in India found ampulla as the commonest (51.61%) part of the fallopian tube where EP occurs.…”

“…EP can be defined as the implantation of the fertilized ovum at sites other than the normal endometrial cavity. 1 It is the main cause of maternal morbidity and mortality in the first trimester of pregnancies with more than 98.0% of the condition occurring in the fallopian (uterine) tube, giving rise to 70.0% ampullary, 12.0% isthmic, 11.0% fimbrial and 2.0%-3.0% interstitial EP. 2 Between 1970 and 1992, the incidence of EP has been on a rise from 4.5 cases to 19.7 cases per 1000 pregnancies globally.…”

“…3 In many hospitalbased studies in Ghana, the prevalence of EP ranges between 3.3%-10.6%. 1,4,5 The etiology of EP is poorly understood. However, several risk factors such as Pelvic Inflammatory Disease (PID), smoking, age, tubal surgical history, previous EP, and chromosomally abnormal embryo predisposes an individual to the condition.…”

“…11 The clinical signs and symptoms of EP includes abdominal pain, vaginal bleeding, adnexal mass, and amenorrhea. 1,13 Early reporting and diagnosis of the symptoms after conception help reduces the risk of tubal rupture/leaking and allows for consecutive medical management. 14 Different studies conducted in Ghana on the burden of EP focused on the diagnosis, clinical manifestations and outcomes.…”